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New technology for keeping alive extremely premature babies has boosted their survival—but these children still lag behind their peers and struggle with maths, reading, and spelling in school.

To evaluate the effect of being very preterm, Dr Peter Anderson of the Royal Women's Hospital in Melbourne and colleagues compared 275 children aged 8 years who had been born extremely small or very prematurely with 223 children of the same age but who were normal weight at birth.